Multiple evanescent white dot syndrome: clinical course and factors influencing visual acuity recovery

Abstract

ObjectiveTo report the demographics and the clinical course of patients with multiple evanescent white dot syndrome (MEWDS) and to investigate for those factors which influence visual acuity (VA) recovery.MethodsThis is a retrospective single-centre observational study. Electronic medical records and retinal imaging of patients with a diagnosis of MEWDS with a minimum follow-up of 3 months were reviewed. Patients were categorised into three groups according to the VA at presentation and at the last visit: group 1 >0.48 logarithm of the minimum angle of resolution (LogMAR), group 2 ≤0.48 and ≥0.18 LogMAR and group 3 <0.18 LogMAR. All patients had non-invasive multimodal imaging including optical coherence tomography, near-infrared reflectance imaging and blue fundus autofluorescence at presentation and during follow-up.ResultsA total of 51 eyes from 51 patients (41 women, mean age 29.8±7.8 years) were included. Significantly more patients presented in the autumn (X2=8.69, p=0.034). The percentage of eyes recovering vision to 0.0 LogMAR or better was 80.3% (41/51). Worse presenting vision and young age at presentation were independent significant predictive variables for poorer final VA (p=0.002 and p=0.02, respectively). No imaging features were significantly predictive of complete versus incomplete recovery, but disc hyperfluorescence on fluorescein angiography was more common in those with incomplete recovery.ConclusionsAlthough the majority of cases have a benign prognosis, the clinical spectrum of MEWDS includes incomplete visual recovery. In our series, poor presenting VA and young age were associated with poor VA outcome. Further study is warranted to confirm these findings.

Comparison of Primary and Secondary Forms of Multiple Evanescent White Dot Syndrome

“…There was only one case of simultaneous bilateral primary MEWDS in the present cohort. In the literature, cases of simultaneous bilateral MEWDS are rarely reported even in the largest primary 28,29 or secondary 18,19 MEWDS cohorts. It is not clear whether these apparently rare cases of simultaneous bilateral forms of MEWDS are more frequently pri-mary or secondary.…”

“…This is not so surprising because cohorts of primary MEWDS actually report recurrence rates of 11% to 14%. 28,29 It is important to note that recurrences of secondary MEWDS in the contralateral eye were always associated with a recurrence of the underlying pathology in the same eye. When the underlying condition was unilateral, MEWDS recurrences remained unilateral, which corroborates the hypothesis regarding the pathogenesis of secondary MEWDS suggested above.…”

Recurrent Multiple Evanescent White Dot Syndrome (MEWDS) Following First Dose and Booster of the mRNA-1273 COVID-19 Vaccine: Case Report and Review of Literature

“…A large retrospective cohort of 111 patients with MEWDS, observed recurrent disease in only 14% of cases [8] Although our patient had improved symptoms after the initiation of corticosteroids, the efficacy of treatment with systemic corticosteroids for MEWDS remains unclear. In a study of 51 patients with MEWDS, those who received systemic prednisone did not achieve a better final BCVA than those who did not; however, lower baseline BCVA at presentation and younger age were predictive of worse outcomes [9]. Although the use of corticosteroids with this subpopulation is reasonable, further studies are needed to determine the efficacy of corticosteroids in MEWDS.…”

Increased incidence and diverse manifestations of Multiple Evanescent White Dot Syndrome during the COVID-19 pandemic

“…Despite the small sample size in the present study, the proportion of female patients was lower (58%) than in previous reports (80-90%). 24,26,27 Cases 5 and 7 had outlier ages, which contributed to the wider age range in Group 2 compared with Group 1; furthermore, Group 2 included the oldest and youngest participants.…”